Mucosal morphology, cell proliferation and faecal bacteriology in acute pouchitis

Abstract

A study was performed to investigate whether acute reservoir ileitis (pouchitis) is associated with specific changes in mucosal morphology, crypt cell kinetics and faecal bacteriology in the ileal pouch. Forty-six patients were studied (ileal reservoir, 36; end ileostomy, ten) using clinical grading, sigmoidoscopy and biopsy; 24 patients with a reservoir were restudied after therapy for 1 month with metronidazole 400 mg three times daily. An index of villus atrophy and crypt cell production rate (CCPR) were determined in all biopsy material. Faecal bacteriology was assessed in 12 patients with a pouch before and after metronidazole therapy. The mucosa of patients with pouchitis was associated with a lower villus atrophy index (P = 0.052), a higher CCPR (P = 0.03) and a higher grade of acute inflammation than that in those without pouchitis. There was no difference in faecal bacterial counts between patients with and without pouchitis. A low atrophy index correlated with a high CCPR (P < 0.001), worse functional score (P < 0.001) and more severe pouch mucosal acute inflammation (P < 0.001), but not with faecal bacteriology. Following metronidazole therapy there was resolution of acute pouch inflammation, increased villus atrophy index (P = 0.049), decreased CCPR (P = 0.049) but no differences in faecal bacterial counts apart from Bacteroides species. These data show that metronidazole therapy does not specifically alter the growth of common faecal bacteria in patients with pouchitis, apart from Bacteroides species. However, metronidazole causes resolution of the typical changes in pouch mucosal morphology and crypt cell kinetics associated with pouchitis.

Clinical and Physiological Aspects of Ileal Pouch-Anal Anastomosis

“…However, bacterial overgrowth alone is probably not sufficient to explain pouchitis, since virtually all pouches have bacterial overgrowth compared to normal ileum or terminal ileostomies. Moreover, quantitative cultures of pouch effluent from patients with pouchitis did not reveal differences in bacterial counts compared with patients without pouchitis (53,57,58).…”

Long‐term efficacy of bismuth carbomer enemas in patients with treatment‐resistant chronic pouchitis

“…Treatment of pouchitis is empirical, and broad-spectrum antibiotics are the mainstay of treatment. Most patients have a good response to metronidazole, which reduces the bacterial counts of bacteroides 14 and the leukocyte in®ltration in the pouch. 15 One double-blind placebocontrolled trial showed a signi®cant reduction of bowel movements, without improvement in endoscopic appearance or histological grade of activity.…”

Benefit of antibiotic therapy on pouchitis after ileal pouch anal anastomosis: A systematic review and meta-analysis of clinical trials

“…The exact etiology of the pouchitis is not very clear; Crohn's disease (CD), recurrent UC [8], toxins, bile acids, and fatty acids can induce inflammation of the pouch [9] that is shown to take part in pathogenesis. Antibiotics are shown to be effective in the management of chronic state of inflammatory bowel disease (IBD) [10,11] and may also be beneficial in pouchitis however, some controversy exists among authorities about the proper treatment choice and management.…”